HomeMy Public PortalAbout9831 FLAHERTY ST_Sewer__ I
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76A642D APPLICATION FORS. PERMIT
6A64
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION TNNEAREST
NG 1
JOHN A. LAMBIE, County Engineer 55 r
WILLIAM A. JENSEN, Sup't of Building
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FOR APPLICANT TO FILL IN ST. _
LEGAL
DESCRIPTION LOT NO OWNER
J® , w MAIL
%
BLOCK TRACT //T/ `/-�•�(l�f/� ADDRESS
NO OF BLDG S*
1'
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF 'M a��
BUILDINGS Gr/e DISTRICT NO GROUP MAP PRESSED BY
BK PG CCC/ Jl
CONTRACTORa. U
ADDRESS , CONNECTION DATA
/f
CITY TEL NO STATION G DEPTH
�/ 4��� STATE MANHOLE REFERENCE
REGISTRATION NO (� /� COUNTY _� LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CO TION LENGTH FROM
HOUSE SEWER CONNECTING TO v Y URB P L. M.L TO P L
PUBLIC SEWER @ $5.00
PC NO
SEPTIC TANK,SEEPAGE PIT OR d
PITS AND/OR DRAINFIELD @ $IO 00 CO IMP NO JOB NO O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300 V dx
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD. INSTR NO. DATE O
WORK TO HOUSE SEWER @ $400 ' V
OVERFLOW SEEPAGE PIT,DRAINFIELD {JJ
EXTN,CESSPOOL,DRYWELL.MANHOLE @ $5 00 ,
ALTER.REPAIR OR ABANDON HOUSE HWY OR ST.WIDENING H
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
I PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 2 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN MED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT T E AB DESCR D E ISTI DWELLING
TO THE PUBLIC SEW APPROVALS DATE INSPECTOR'S SIGNAT� E
SIGNED THIS AY F 19 A e I `.�
OWNER OR NEW HOUSE SEWER V y
OWNERS AGEN CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PIT(S)
1 HEREBY CKN DGE THAT I HAVE READ THIS PLICATION AND/OR DRAINFIELD
AND STAT THAT E ABOVE IS CORRECT AND AGRE TO COMPLY
WITH ALL COU Y ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAr�STC
HE LEG L NER AND INTEND DISCONNECT PLUG AND
RESIDE IN, THE ABRIBER I NTIA ROPE RTY ABANDON HOUSE SEWER
SIGNATURE L�
OF PERMITTEE r BACKFILL SEPTIC TANKS
SEEP,PIT(S) ❑ CESSPOOLS
0CKALIDATION ROBERT"A. WOOD M O CASH I v
SUPERVISING MECHANICAL ENGINEER
ULo 4 584%-L OCT 6 1 0 D 7.0 0-